1. Kingston, Mary Beth PhD, RN, NEA-BC, FAAN


Mary Beth Kingston, PhD, RN, NEA-BC, FAAN, chief nurse executive of Advocate Aurora Health and past president of the American Organization for Nursing Leadership (AONL), interviews her mentor, Joanne Disch, PhD, RN, FAAN, who serves on the Advocate Aurora Health Board of Directors and was the inaugural chair. Dr Disch also serves as chair of the Chamberlain University Board of Trustees and is professor ad honorem at the University of Minnesota School of Nursing. This is an abridged version of the interview, which took place at the AONL Virtual Conference in 2020.


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Dr Kingston: You are a generous leader, sharing experiences, whether it is about board service, association leadership, or career moves. You've spoken and written about professional generosity. Can you describe that concept and discuss how it has influenced your career and professional relationships?

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Dr Disch: The concept was introduced to me almost 20 years ago when I was on a plane and next to me was a nurse. We talked the whole time, both of us very excited. And she was giving me some advice. She was a coordinator of a clinical trial for oncology and I had just had breast cancer treatment. Conversely, she had a whole lot of questions about how to handle a really challenging employee issue, and so I had advice for her. At the end of the flight, she said, "Thank you for your professional generosity." It's the idea that you freely give, whether it be expertise or resources or your time, to a colleague. There's no quid pro quo; you just want to help somebody do their best work. I started to think about all the ways that nurses have been professionally generous to me. Giving me their time, advice, or a hand up. I also began to appreciate what professional stinginess is. I worked with a few people who held resources too close by not sharing information. They might not include me in work groups in which my participation would be appropriate[horizontal ellipsis]so I've just come to really appreciate this concept because I've been so fortunate to work with colleagues over my career that were so professionally generous.


Dr Kingston: By all accounts, you have had a tremendously successful professional life. When people see that, they might think you have not had serious challenges. Can you highlight a barrier or challenge that you faced along the way and the insights you gained as a result?


Dr Disch: I have had wonderful moments in my career, but there also have been some setbacks and challenges; interestingly, that really helped me. Of course, at the time, you do not see it that way. My mantra has always been information is power, but relationships are the key. For me, how I connect with people and how I work with and through others is very important. It's a real cornerstone. Some of the relationships that did not either start out or end up the way I had thought they would, helped me learn more about myself and about being a leader. When I was first chief nurse executive (CNE) at an academic medical center, I went in to meet my chief operating officer (COO) colleague to establish a collaborative relationship. I found him dismissive. We'd go into meetings and he'd say, "Would you take minutes? I do not have a pen." He would all but ask me to get his coffee. We embarked upon a years-long effort to get to know each other and for me to understand his story. I look back now and realize I was using my assessment and nursing diagnostic skills to get at what the story was. I learned his mother had been a nurse and he had been treated poorly by some of the nursing staff. I came to understand he was insecure and actually intimidated by nurses. A lot of things unfolded until we really developed an incredibly collaborative relationship and got to the point where his wife said, "You're his best friend."


Because of that experience and others, I gained insight. When you first meet people and they irritate you or there's something about them you do not like, I ask myself, "What is it about them that is really irritating me? What does it say about me? What can I learn? What's their story?" Then I spend time to learn the answers. I'm not saying every situation works out. But often, when I persisted, I learned more about myself and developed professionally generous relationships.


Dr Kingston: Your board service has been extraordinary-president of the American Association of Critical Care Nurses and the American Academy of Nursing, board chair of AARP, the inaugural board chair of Advocate Aurora, just to name a few. Are there commonalities in board service? What unique attributes do nurses bring to boards?


Dr Disch: If you are on any type of board, whether it be national or local, there's work to be done. You've got to prepare, you have got to speak up appropriately, but not too much. You need to be a financial steward for the organization. On a health system board, my job is not to be the nursing advocate. The CNE should fulfill that role. I certainly bring nursing into everything I do. Nurses know on the ground level what healthcare means, what it has to look like, what threats to safety and quality are. We are relationship based, see the big picture, and yet can be focused on the details of a particular patient and their family. I call it the nursing lens. It's a way that nurses approach situations and think about issues; we are very pragmatic and creative, because we have solutions. Every board needs a nurse. Every health system board needs at least 1, if not 2 or 3.


Dr Kingston: I think having a nurse there changes the conversation and the focus. Everybody's concerned about care quality, but everybody does not understand what that means in clinical practice. Once at a board meeting for our health system, I was talking about turnover and overtime. One of our board members who is a business leader said, "My team loves overtime." We then discussed that consistently working 20 hours of overtime a week in nursing can have a negative impact on staff well-being and patient safety.


Dr Disch: Your point is well taken about how nurses can frame an issue. When people say, "Well, we have doctors on the board. Why do we need nurses?" This is not an issue of parity. Nursing leaders should not think, "Because we have a doctor, we have to have a nurse." No, this is about perspective. Nurses know what happens on a unit at 2:00 AM, and physicians may not. Physicians should be on the boards, along with nurses, because of the perspective each clinician brings.


Dr Kingston: What are the most important things nurse leaders need to do in times of crisis? What characteristics do they need during the pandemic?


Dr Disch: Being a leader today is hard. At times in my career, I've phrased it as taking people on a journey on which nobody wants to go. As I face issues and challenges as a nurse leader, it's best to bring together a team. We've got to bring people in to help with our ideas and think of new ways to address problems. Time matters and sometimes we have to move before everybody is on board. I am convinced we have to think differently. We have to challenge ourselves to not rush back to the way we used to do things, we may need to try something new. Here's an example: people say we need more nurses. We may not be able to find more nurses. What if we change the question and ask, "How do we increase the capacity to provide nursing care?" Then we have got a lot of options other than hiring nurses. And so if we can help people during these crises think differently, they will look at options previously not considered. In times of crisis, it's important to get people together to brainstorm, to move expediently, and to challenge ourselves to see new solutions.